Presentation of malignant pleural mesothelioma with cerebral metastases

Our plain-English summary of Presentation of malignant pleural mesothelioma with cerebral metastases, by W.M. McNaughton, M.E. Broughton, G.C. Toner, et al (Journal of the Royal Society of Medicine, 1990).

The study

• Authors: W.M. McNaughton, M.E. Broughton, G.C. Toner, M.A. Schwarz
• Journal: Journal of the Royal Society of Medicine
• Published: 1990;83(7):466-7
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003844).

Summary of the article

The authors reported a case of malignant pleural mesothelioma that first showed itself through symptoms of brain involvement, a presentation they said had not apparently been described. A 63-year-old Caucasian man, a non-smoker who had worked as an industrial plumber with known heavy asbestos exposure for 24 years, had 7 months of right shoulder pain and 2 weeks of weakness in the right hand. Chest X-ray showed a large right pleural opacity with rib erosion. At thoracotomy the mass was removed together with the 3rd, 4th and 5th ribs and a sliver of the right upper lobe. He then had one cycle of cyclophosphamide, doxorubicin and dacarbazine. His hand weakness kept getting worse, and computed tomography showed metastases in both sides of the brain. High-dose dexamethasone and 30 Gy whole-brain radiotherapy almost completely resolved his neurological symptoms. After 2 months he developed new weakness and difficulty speaking, and he died 3 weeks later. At necropsy no tumour had recurred in the chest. Five deposits of 1 to 2 cm were found in the brain, and their appearance under the microscope matched the original tumour. The authors cited necropsy series reporting 4 cases of brain metastases in 132 mesothelioma autopsies, and 9 in 207 Australian surveillance cases. They concluded that spread of mesothelioma to the brain is more common than generally recognized.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a case report of one patient. A 63-year-old Caucasian man presented with seven months of right shoulder pain and two weeks of right-hand weakness. He was a non-smoker who had worked as an industrial plumber with known heavy exposure to asbestos for 24 years. The article did not name a fiber type. A chest X-ray showed a large right pleural opacity with rib erosion, and a mass on the chest wall was removed by surgery. After one cycle of chemotherapy the hand weakness kept getting worse, and computed tomography (CT) showed metastases on both sides of the brain. Steroids and whole-brain radiotherapy nearly cleared the neurological symptoms. They returned after two months, and the patient died three weeks after coming back to hospital. At autopsy no recurrent tumour was found in the chest, and five deposits 1 to 2 cm across were found in the brain. The authors judged the tumour's appearance consistent with malignant pleural mesothelioma. They wrote that their review of other reports suggests spread of this cancer to the brain is more common than generally recognized.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, with necropsy), plus a brief review of earlier reports in the discussion
• Who was studied: one 63-year-old Caucasian male patient, a non-smoker, treated in Victoria, Australia (Dandenong & District Hospital and Alfred Hospital)
• Exposure: occupational asbestos exposure as an industrial plumber, described as known heavy exposure over 24 years; no fiber type named
• Main results:
  • Chest X-ray showed a large right pleural opacity with rib erosion
  • At surgery the mass was localized to the chest wall and was resected
  • After one cycle of chemotherapy, right-hand weakness continued to increase and CT showed bilateral cerebral metastases
  • High-dose dexamethasone and 30 Gy whole-brain radiotherapy led to virtual resolution of all neurological symptoms
  • The patient was clinically well for 2 months, then developed recurrent right arm and leg weakness and dysphasia, and died 3 weeks after re-presentation
  • At necropsy there was no recurrent tumour in the chest
  • Five metastatic deposits, 1 to 2 cm in diameter, were found in the right temporal lobe and both parietal lobes of the brain
  • Tumour appearance at biopsy and necropsy was judged consistent with malignant pleural mesothelioma; staining for glial fibrillary protein in the brain deposits was negative
• The authors' conclusion: The authors wrote that their review suggests spread of malignant mesothelioma to the brain is more common than generally recognized; they also stated that presentation with brain symptoms had apparently not been described before

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Chest X-Ray, Thoracotomy, Doxorubicin, Autopsy, Mesothelioma.

Related studies

• Sarcomatous mesothelioma of the pleura with cerebral metastases — C. Nielsen, I.M. Hansen (1990)
• Malignant mesothelioma with brain metastases — J.A. Kaye, A.M. Wang, et al. (1986)
• Malignant mesothelioma and central nervous system metastases. Report of two cases, pooled analysis, and systematic review — A.C. Miller, M. Miettinen, et al. (2014)
• Brain metastases in malignant pleural mesothelioma. Case report and review of the literature — K.S. Sridhar, A.M. Hussein, et al. (1989)
• Brain metastases in malignant pleural mesothelioma — T. Yamagishi, N. Fujimoto, et al. (2016)
• Response to chemotherapy of brain metastases from malignant pleural mesothelioma — M. Colleoni, G. Liessi, et al. (1996)

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